Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources

The aim of the study was to determine the contemporary socio-clinical profile and perinatal outcome of illicit substance use in pregnancy in a large UK city and compare with published literature. Cases were identified retrospectively from the 'cause for concern' referrals over 5 years (2003-2007). Data was collected on mother-infant pair from medical notes and laboratory records. Chi-square and Mann-Whitney U tests were used where appropriate for statistical analysis. One hundred sixty-eight women were identified as using illicit substance in pregnancy. Smoking (97.4%), unemployment (85.4%) and single status (42.3%) were frequent. Besides controlled use of methadone, heroin, cannabis and benzodiazepines were the most commonly used drugs. Hepatitis C prevalence was high (29.9%) despite low antenatal screening rates (57.7%). Neonatal morbidity was related to prematurity (22.9%), small for dates (28.6%) and neonatal abstinence syndrome (NAS; 58.9%). By day 5 of life, 95.1% of the babies developing NAS and 96.1% of those requiring pharmacological treatment were symptomatic. Of the infants developing NAS, 31.7% required pharmacological treatment. A total of 82.5% babies went home with their mother, and 21.2% were placed on the Child Protection Register. Only 14.3% were breast feeding at discharge. Illicit substance use in pregnancy continues to be associated with significant maternal and neonatal morbidity, and the socio-clinical profile in this decade appears unchanged in the UK. Hepatitis C prevalence is high, and detection should be improved through targeted antenatal screening. Where facility in the community is unavailable, 5 days of hospital stay is sufficient to safely identify babies at risk of developing NAS. Most babies were discharged home with their mother.

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“…Polydrug use was common, despite an active methadone programme. This trend is similar to that noted in other studies [1,2,9,24].…”

Section: Discussionsupporting

confidence: 92%

Perinatal outcome of illicit substance use in pregnancy—comparative and contemporary socio-clinical profile in the UK

et al. 2010

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“…Brown et al (1998), reporting on 32 MMT pregnancies, found three major congenital abnormalities, two of which were fatal: a cardiac anomaly and a diaphragmatic hernia (p<0.001). In the study published by Arlettaz et al (2005), fourteen congenital malformations were described in 12 of 78 newborns (15%). One newborn with multiple malformations died at 1 year of age.…”

Section: Teratogenecitymentioning

confidence: 97%

“…Duration of hospitalization ranged from 8 to 105 days (median 25 days). Arlettaz et al (2005) in a study of the impact on neonates of MMT in pregnancy analyzed 86 live births of over 24 weeks gestation and found that 49 of 79 newborns (62%) born to mothers receiving MMT required pharmacologic treatment for NAS; and that the incidence of NAS was proportional to the dose of maternal methadone. At methadone doses below 30 mg/day, 43% of newborns required treatment.…”

Section: Neonatal Abstinence Syndromementioning

confidence: 98%

Management of Opioid Dependence in Pregnancy: A Review of the Evidence

Young

2007

Int J Ment Health Addiction

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Conventional wisdom regarding management of opioid dependence in pregnancy calls for methadone maintenance in nearly all cases. The scientific literature and historical background upon which this recommendation is based, newer evidence indicating the safety of methadone discontinuation during pregnancy and recent studies raising concerns about the effects of methadone on the fetus and neonate are reviewed. More flexibility in the management of opioid dependence during pregnancy is recommended.

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“…Nachteil der Methadonsubstitution während der Schwangerschaft ist die Entwicklung eines neonatalen Entzugssyndroms (NAS) in 30 -80 % der Fälle [4,15]. Das NAS, das seinen Gipfel etwa 48 -72 Stunden postnatal erreicht, wird in seiner Symptomatik im Allgemeinen nach einem Score nach Finnegan beurteilt [16].…”

Section: Stillen Und Das Neonatale Entzugssyndromunclassified

Opiatabhängigkeit und Stillen - Literaturübersicht und Empfehlungen

Kashiwagi¹,

Schäfer²,

Kästner³

et al. 2005

Geburtsh Frauenheilk

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Die Empfehlungen zum Stillen bei opiatabhängigen Müttern bleiben ein viel diskutiertes Thema. Da Methadon derzeit Standard in der Substitutionsbehandlung opiatabhängiger Schwangerer ist, wurden für diese Substanz auch verschiedene Studien zur Abschätzung des Risikos für gestillte Neugeborene durchgeführt. Nach Durchsicht der aktuellen Literatur rechtfertigt die reine Opiatsubstitution nicht mehr das primäre Abstillen. Obgleich die untersuchten Fallzahlen klein sind, konnte in der Muttermilch abhängiger Mütter, als auch im Plasma deren Neugeborener, Methadon in nur minimalen Konzentrationen nachgewiesen werden. Offensichtlich variiert der Methadonmetabolismus individuell, so dass die Dosis kaum mit den Plasmaspiegeln korreliert. Veraltete Empfehlungen, Stillen ausschließlich bei sehr niedriger Methadondosis zuzulassen, wurden daher revidiert. Bei Methadonsubstitution muss jedoch an die Möglichkeit eines politoxikomanen Beigebrauches sowie an das Vorliegen einer HIV-Infektion gedacht werden, in diesen Fällen ist vom Stillen abzuraten. Schlüsselwörter Methadon · Opiatabhängigkeit · Buprenorphin · Stillen AbstractWeaning in opiate addicted mothers remains a matter of debate. As methadone is the substance of choice in the treatment of opiate addiction in pregnancy, various studies have been conducted to evaluate its potential risk for the breastfed neonate. Reviewing the current literature we came to the conclusion that study results are not sufficient to recommend general weaning in women under opiate maintenance treatment. Although the numbers of cases investigated are small, the concentration of methadone or alternative opiates in breast milk or the infant's plasma seems to be neglible. Prior recommendations to promote breastfeeding only in mothers treated with lower methadone doses have had to be retracted. There is now evidence that methadone metabolism differs individually and a correlation between methadone dosage and maternal plasma concentrations has not been confirmed. Nevertheless polytoxic behaviour with consumption of various toxic substances has to be taken into consideration and likewise the high infection rate with HIV in the opiate addicted patient. In these cases weaning should be recommended.

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Methadone maintenance program in pregnancy in a Swiss perinatal center (II): neonatal outcome and social resources

Cited by 29 publications

References 18 publications

Perinatal outcome of illicit substance use in pregnancy—comparative and contemporary socio-clinical profile in the UK

Perinatal outcome of illicit substance use in pregnancy—comparative and contemporary socio-clinical profile in the UK

Management of Opioid Dependence in Pregnancy: A Review of the Evidence

Opiatabhängigkeit und Stillen - Literaturübersicht und Empfehlungen

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